Continuing last week's look at the history of Kingston Hospital, which began as an infirmary set up by the Guardians of the Poor as an adjunct to Kingston Union Workhouse.

Caring for the sick became an ever-increasing part of the workhouse regime a fact noticed with chagrin by the local ratepayers who had ultimately to foot the bill. In 1868, the Comet noted that of the 344 inmates, no fewer than 260 were under medical care.

"It certainly does seem as if workhouses, as they are called, are fast being converted into infirmaries," the Comet remarked.

Thus the first workhouse infirmary of 1843 (pictured last week) was inadequate almost as soon as built, patients often having to lie on the floor through lack of space. There were years of what the Comet described as "a great amount of talk, a still greater amount of correspondence, many resolutions, counter resolutions, amendments and rescindings of former resolutions" before an additional infirmary was finally completed in 1868. Designed by Charles Luck of Surbiton, it had beds for 80 patients in eight wards, with a "dead house" in the basement.

The Comet thought the building "a decided ornament to the locality" and the last word in modernity.

"The wards are built upon the principle now adopted in modern hospitals, with windows on both sides so as to ensure ventilation," it reported. "They are all lighted with gas, and heated by means of open fireplaces, which serve to add cheerfulness to the wards."

The Comet was at pains to assure disgruntled ratepayers that their £7,000 had been well spent.

"None but the medical officer, the resident officials and the guardians have been able to fully realise what an extremity the workhouse master was put to provide rooms for the sick," it declared, adding that the new facilities would not only give increased comfort to the sick poor, but assist their recovery to health and strength. In other words, they would no longer be a charge on the rates!

But the 1868 infirmary now called the Regent Wing, and the only surviving remnant of the old workhouse complex was soon working to capacity and, though it was eventually extended in 1894, it was clear a third infirmary was required.

In 1897, after the usual protracted arguments, the guardians gave the go-ahead for a new male infirmary, nurses' home and porter's lodge at a total cost of £18,200. The foundation was laid in November 1897 but, because of the customary difficulties and disagreements, the building was not completed until two years later, by which time costs had risen to £22,832.

It had 132 beds in 15 wards and was praised as "one of the most beautifully fitted institutions of its kind." Heating came from "warm air stoves and hot water coils", and its landmark feature was a central tower containing, in the words of the guardians' report, "a reserve water tank at an altitude sufficient to serve all parts of the house." Another attractive feature was balconies where patients could enjoy the fresh air. But these were later blocked out by a modern infill.

Details of the treatment given in the Kingston Union infirmaries are sparse, but it's clear that beer and wine were considered prime tonics. Nursing mothers, for example, were prescribed a pint of beer daily and port was regularly administered to patients until well into the 20th century.

The Kingston infirmaries had no ambulances until 1897. Accident cases were brought in by furniture van, or any other available vehicle, until a guardian moved that "an ambulance drawn by a horse ought to be at hand for use in such a large Union, and without it we shall be behind the times." His resolution was accepted.

A landmark in Kingston Hospital's history was 1902, when it was separated from the workhouse and named Kingston Infirmary.

The medical staff consisted of a resident doctor who worked under the direction of a part-time medical officer, and during the year, 92 patients were treated.

For 11 years the infirmary continued with just these two doctors and 47 nurses. But in 1912, when no fewer than l,615 patients were admitted, the guardians realised that the lone full-time doctor was severely overworked, and they appointed another. He was Dr Vernon Davies, who in 1919 was promoted to the new post of full-time medical superintendent.

Another milestone was the First World War, when many beds were reserved for military casualties, and improved surgical equipment was installed to deal with them.

The war did more than anything else to show how efficient Kingston's Poor Law infirmary could be; and after the war it began treating patients from the long waiting lists at the general hospitals in the area.

The only obstacle was prejudice. The word "infirmary" was inextricably linked with the Poor Law and pauperism, which is why the guardians replaced it in 1920 with the name Kingston and District Hospital.

It was a shrewd move. From then on non-pauper patients were no longer embarrassed to go there for treatment.

Facilities at the hospital improved steadily until 1930 when, after nearly a century, boards of guardians were abolished and replaced by Public Assistance Committees. The Kingston guardians mourned the change, but had the satisfaction of knowing that their hospital had been judged the best in the county by the new Public Assistance Committee for Surrey, who renamed it the Kingston and County Hospital.

In 1913 Kingston Infirmary had 47 nurses. By 1930, Kingston and District Hospital had 107, and their training and certification was recognised as being equal to that given in general hospitals. There was also a fine new nurses home, fronting Wolverton Avenue and Kingston Hill, and formally opened in 1928 by the Duchess of York later Queen Elizabeth, consort of George VI.

In 1931, a year after the departure of the guardians, the Comet sent a reporter to check conditions. He found the hospital had 600 beds, 122 nurses and three staff doctors plus Dr Davies, who was still medical superintendent. His workload was extraordinary. He carried out most of the surgery himself a total of 800 operations in 1930. He also spent four hours a day visiting patients, had to be consulted on every case admitted, and was responsible for directing the whole organisation and taking the blame for any mistakes made by staff. Small wonder he usually worked until 2am.

Between four and five thousand cases a year were being treated at that time, and a disturbing rise in motor accident cases was noted. In 1920 there had been 16. In 1930 that had increased to 240.

The reporter was impressed by the modern operating theatre, the "massage and electrical" department and the fact that every bed was equipped with a wireless. He also praised the role of the Almoner the picturesque old word for what we now call a hospital social worker.

He marvelled that the laundry washed no fewer than 21,699 items per week, and in the nurses' home enthused over the "jolly bedrooms, fitted with every convenience, and in which any woman could feel thoroughly happy and at home."

By 1936 plans had been prepared for the rebuilding of the hospital, but World War II halted the scheme.

In 1948 the National Health Service was launched, and a Group Hospital Management committee was appointed by the South West Metropolitan Hospital Board. The following year the workhouse re-named the Central Relief Institution was transferred to the Regional Hospital Board.

The regional board, with the whole of the former Kingston Union site at its disposal, began planning its development as an integrated hospital in four phases.

The first was a new outpatients department, started in 1959 and officially opened by Princess Alexandra in 1963. Then came the medical centre, built in 1962, and formally opened by the then Minister of Health, Enoch Powell. Kenley Ward, built at a cost of £75,000, was opened by Prof Sir Max Rosenheim in 1968 as a short-stay psychiatric unit. Also in the 1960s, Lord Taylor opened the kitchen, dining rooms and store, built on the site previously occupied by the original workhouse of 1830.

In 1968 a new boilerhouse and works department was built on land adjoining the Galsworthy and Coombe Roads. This heralded the start of phase two: the construction in the 1970s of what became known as the Esher Wing. A new mortuary was also built and, later, the dental wing, officially opened by Princess Alexandra in 1988.

Phase three was the fine Bernard Meade Wing, opened by Princess Alexandra early in 1992. Phase four, started in 1993, was a new maternity unit and surgical day centre.

A key date was April 1, 1991 the day it became one of Britain's first NHS Trust hospitals, with its own board of managers. The following year it treated a record of 34,000 patients and began planning a fifth phase of improvements.

A major component of phase five is replacement of the current Roehampton Wing with a £23million block containing new surgical wards, physiotherapy accommodation, education and training centre, kitchen, dining room and care centre.

The project is due to open next summer. Work will also start soon on demolishing the 1928 nurses' home and replacing it (in partnership with a local housing association) with a new one. Meanwhile The Sir William Rous Cancer Unit will offer facilities not previously available in Kingston.

Already in place are an £800,000 eye cataract theatre and a clinical decision unit, both opened last year, and a state of the art accident and emergency unit, opened in December 2002.

All this, plus the fact that an overall total of 344,422 patients were treated last year, would surely impress the 21 Guardians of the Poor who laid the foundations of Kingston Hospital in Farmer Dickens' field in 1843.ingston Union Workhouse.